临床药师在高血压伴高同型半胱氨酸血症中的药学服务

目的 探讨心血管内科临床药师在高血压伴高同型半胱氨酸血症中的药学服务，体现其在安全、合理、有效用药等方面的价值。方法 临床药师参与1例青年高血压伴高同型半胱氨酸血症病例的治疗全过程，结合患者的具体病情，应用药学的专业知识，从药物的选择、剂量推荐、安全性及有效性方面，协助临床医师制订降压、控制心率及降同型半胱氨酸水平的治疗方案，并实施药学监护，分析总结临床药师在该疾病中的药学服务。结果 根据患者血压和心率情况，先后使用富马酸比索洛尔片和盐酸依伐布雷定片降压的同时控制心率；评估患者的同型半胱氨酸水平，建议予以叶酸片治疗。治疗后患者血压、心率得到控制，出院3个月后复查同型半胱氨酸已基本下降至正常水平。结论 临床药师对高血压伴高同型半胱氨酸血症患者的药物选择进行了分析并进行药学监护，为其提供了优质和个体化的药学服务，提高了药物治疗的安全性、合理性及有效性。

Pharmaceutical Service of Clinical Pharmacists in Hypertension with Hyperhomocysteinemia

OBJECTIVE To explore the pharmaceutical service of clinical pharmacists of cardiovascular medicine in hypertension with hyperhomocysteinemia, and to reflect its value in safe, reasonable and effective drug use. METHODS Clinical pharmacists participated in the whole treatment process of a young patient with hypertension accompanied by hyperhomocysteinemia. Combined with the patient''s specific condition, clinical pharmacist applied their professional knowledge of pharmacy to assist clinicians in formulating treatment plans for lowering blood pressure, heart rate and homocysteine level from the aspects of drug selection, dose recommendation, safety and effectiveness, and to carry out pharmaceutical monitoring, and analyzed and summarized the pharmaceutical care of clinical pharmacist in this disease. RESULTS According to the patient''s blood pressure and heart rate, bisoprolol fumarate and ivabradine hydrochloride were successively used to control the heart rate and blood pressure. Clinical pharmacists suggested the use of folic acid to control the homocysteine levels. The patient''s blood pressure and heart rate turned to normal, and homocysteine had basically decreased to normal level after three months treatment. CONCLUSION Clinical pharmacists analyze and suggest the drug selection of patients with hypertension accompanied by hyperhomocysteine, and provide them with high-quality and individualized pharmaceutical care, which improve the safety, rationality and effectiveness of drug therapy.